On the pulse

At the RCN Congress in Liverpool this week, some of the most pressing issues facing the nursing profession were on the agenda. In particular, two stories covered by Nursing Times highlighted the need for greater awareness of the value of some nursing roles.

Requiring student nurses to complete a year’s caring experience before they are accepted onto a degree course is a really bad idea, says Elaine Maxwell

1. Where is the evidence that the problem is with newly qualified nurses not caring?

Julie Bailey tweeted this morning that student nurses were the most compassionate on ward 11 at Mid Staffs.

2. There is no evidence this will improve compassionate care.

It fact there is strong evidence suggesting the opposite. Staff are socialised to their experience and if the student nurse works with an HCA who displays poor behaviour the student nurse will learn these and need to unlearn them as an HCA.

3. Devalues the theory on compassion and caring

This suggests care is an unskilled job, Florence would turn in her grave.

We need more school leavers but if they have to do one year as an HCA before to university this will deter them. There will be a crisis with even less RNs in 8- 10 years, making care even worse.

6. This reinforces focus on nursing as a hospital based role

What about all the other areas than we need to expand into in order to redesign services?

7. In the current times of austerity, HCA roles may not be available for potential recruits

Universities cannot provide this experience as they don’t run the service. Will hospitals have to fund the experience? Will they be able to hold posts for potential recruits? What will this do to the stability of the service workforce or will potential students have to do this on a bursary?

8. This does not recognise the issue of staffing numbers.

The nicest nurse in the world cannot give bedpans to five people simultaneously.

9. This doesn’t recognise that the culture in which care is provided is multi professional

Will medical students have to do this too?

10. The argument against minimum staffing is that standards are strongly related to ward leadership

But ward leadership is not considered here.

Having trained as an SRN in the 1970s, I would say changes changed not when P2K came in but when the role and authority of the Ward Sister were undermined in 1990s

Education chiefs have questioned claims in the NHS Long Term Plan that “well-qualified” student nurse applicants are being rejected a place on a course because some universities are setting the bar too high.

A nurse who helped with the complex arrangements for a patient to receive end of life care in her country of origin, having only qualified relatively recently, has been praised for her work by her trust.

Readers' comments (27)

I entirely agree with Elaine' summary, the only benifit I can see is that those coming into the profession will be doing so with their eyes wide open and will have a greater appreciation of the challenges and will be able to decide at an early stage in their career if nursing is for them.

If the government thinks this is a way of simply improving 'compassion in care' they are grossly underestimating the complexity of the problem.

Why not just re-introduce ward based training, with continual assessment of attitude, behaviour, appearance etc all thrown in with clinical skills. Bring back experienced clinical facilitators and if student nurses are not up to scratch then give them a chance to improve their performance/behaviour/attitude and if they don't then they are should not finish the course. Do away with skills labs and train student nurses to care for real people, not plastic models.
Bring back a course that EVERYONE suitable can apply for, have an entrance exam and a face-to-face interview with senior nurses at the Trusts where student nurses are likely to be placed.

I have personal experience with #5. In the late 90's with a Master's Degree, I considered going to nursing school, and found that I would have to take a six-week course in HCA just to matriculate. That was cost-prohibitive for someone already planning to take a year off work and pay nursing tuition also. So, I did not go to nursing school until that requirement was lifted.

I agree with Number one i am a student nurse and i have noticed the problem isn't with student nurses as it is us who have more time to communicate and care for patients. at mid staffs it wasn't student nurses who didn't show compassion it was the minority of nurses so instead of giving student nurses extra training in compassion why don't they give nurses mandatory training each year for all nurses in basic care tasks including newly qualified and also the ones who have been nurses a long time.

Personally I find it a little odd to ask nurses to spend a year as an HCA when there is no appetite to regulate the latter.
Winterbourne view produced visual evidence of where a lack nursing leadership had HCA's try to socialise new members of staff into an abusive behaviour.
How does the government support that nurse leadership that these recent reports clearly show a lack of?

. Hcsw are there to care and have as much compassion as any other care worker to suggest that student nurse would pick up bad habits if working as a hcsw is insulting and nonsense. Stop tarring every one with the same brush give everyone the training to ensure they meet the standards and basic nursing care starts there.

Brilliant, totally agree with this! The issue needs to be taken from other angles, for example force Trusts to release clinicians for interviews at Universities instead of them increasing having to attend in their own time and out of their own motivation and interest.
Nurses take bakc the nursing role and expertise with HCAs 'assisting' as delegated.
Remember, student nursues are continuously assessed in clinical practice for at least 50% of their course and that assessment is liem it was for us, carried out by registered nurses.

I wish that politicians would stop vox popping for votes. The politicians and their media pals are demonising nurses because they are an easy target. Let administrators administrate and let nurses nurse, and the "problems" will go away.

In my experience, the majority of students worked along side assist trained nurse, HCAs s in delivering care, some preferred to remain totally supernumerary. I recall one occasion, a student who had been on placement for 2 months came on to work a weeks night shift. The bank health care assistants happened to be late that evening, leaving the student and my self to manage the ward..CORRECTION..MY SELF. There where three clients on level observation, 2 clients on one to one, and the third on close. This student did absolutely nothing to help me, did not use initiative in any way, did not even assist me with the drug round. The student just sat there looking at me arms folded. Yes students should undertake cadet nursing prior to training. Prior to my training I worked for a year as an auxiliary nurse, gaining valuable experience on male and female geriatric wards, and other areas. A decent student who is well focused and genuinely interested in his/her chosen career would have supported me.

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